BACKGROUND: During the COVID-19 pandemic, global healthcare systems faced unprecedented challenges, with a lack of resources and suboptimal patient care emerging as primary concerns. METHODS: Our research, using a comprehensive 24-item electronic questionnaire, "Reflections on the Provision of Healthcare during the COVID-19 Pandemic," delved into the experiences of 938 physicians across the Czech Republic. RESULTS: Over fifty per cent observed a "lower standard of care" compared to pre-pandemic levels. A division arose among physicians regarding a decision's medical, ethical, or legal basis, with a notable gender disparity: male doctors leaned towards medical perspectives, whereas females accented the ethical perspective. Decision-making concerning health care limitations required agreement among the physicians on duty, interdisciplinary teams, or shift supervisors. Physicians reported varying degrees of patient or family participation in health care decisions. Variables such as age, pre-existing health conditions, and life expectancy influenced care decisions. Surprisingly, half of the physicians faced refusals of patients' transportation to better-equipped facilities due to resource constraints. One-third of physicians never discuss the decision about care limitation and other options with patients or their families. As a result, almost fifty per cent of the physicians rarely or never imparted information about care limitations to patients. CONCLUSION: The survey shed light on the profound ethical dilemmas hospital physicians face across different types of healthcare facilities during the pandemic. It uncovered the need for open dialogue and scholarly debate on resource allocation and strengthening the role of patients and their families in care decisions in future healthcare crises.

1st Department of Tuberculosis and Respiratory Diseases 1st Faculty of Medicine General University Hospital Prague Charles University Prague Czech Republic

Department of Nursing and Midwifery Faculty of Medicine University of Ostrava Ostrava Czech Republic

Department of Palliative Medicine 1st Faculty of Medicine General University Hospital Prague Charles University Prague Czech Republic

Zobrazit více v PubMed

WHO Official COVID-19 info. https://covid19.who.int/

McGuirea AL, Aulisio MP, Davis FD, et al. Ethical challenges arising in the COVID-19 pandemic: an overview from the Association of Bioethics Program Directors (ABPD) Task Force. Am J Bioeth. 2020;20(7):15–27. 10.1080/15265161.2020.1764138. PubMed

Emanuel EJ, Persad G, Upshur R, et al. Fair allocation of scarce medical resources in the time of Covid-19. Mass Med Soc. 2020;382:2049–55. 10.1056/NEJMsb2005114. PubMed

Marckmann G, Neitzke G, Schildmann J, et al. Decisions on the allocation of intensive care resources in the context of the COVID-19 pandemic. Med Klin Intensivmed Notfmed. 2020;115(3):115–22. 10.1007/s00063-020-00709-9. PubMed PMC

White DB, Lo B. A Framework for Rationing ventilators and critical care beds during the COVID-19 pandemic. JAMA. 2020;27:E1–2. 10.1001/jama.2020.5046. PubMed

Oliveira HC, Sauthier M, Silva MM et al. Do-not-resuscitate order in COVID-19 times: bioethics and professional ethics. Rev Gaúcha Enferm. 2021;42(spe):e20200172. 10.1590/1983-1447.2021.20200172. PubMed

White FJ. The prioritization of life-saving resources in a pandemic Surge Crisis. Issues Law Med. 2020;35(2):99–116. PubMed

Giannini A. Who gets the last bed? Ethics criteria for scarce resource allocation in the era of COVID-19. Minerva Anestesiol. 2021;87:267–71. 10.23736/S2724-4407.20.15345-8. PubMed

Dao B, Savulescu J, Suen J, et al. Ethical factors determining ECMO allocation during the COVID-19 pandemic. BMC Med Ethics. 2021;22(1):70. 10.1186/s12910-021-00638-y. PubMed PMC

Dufner A. Withdrawal of intensive care during times of severe scarcity: triage during a pandemic only upon arrival or with the inclusion of patients who are already under treatment? Bioethics. 2020;35:118–24. 10.1111/bioe.12837. PubMed

Hasselkusaand A, Moxley AD. Communicating with patients and families during COVID-19. Perspectives. 2021;6(4):924–32. 10.1044/2021.

Bernild C, Missel M, Berg S. COVID-19: lessons learned about communication between Family members and Healthcare professionals - a qualitative study on how close family members of patients hospitalized in Intensive Care Unit with COVID-19 experienced communication and collaboration with Healthcare professionals. Inquiry. 2021;58:469580211060005. 10.1177/00469580211060005. PubMed PMC

Rose L, Yu L, Casey J, et al. Communication and Virtual Visiting for Families of Patients in Intensive Care during the COVID-19 pandemic: a UK National Survey. Ann Am Thorac Soc. 2021;18(10):1685–92. 10.1513/AnnalsATS.202012-1500OC. PubMed PMC

Dittborn M, Cave E, Archard D. Clinical ethics support services during the COVID-19 pandemic in the UK: a cross-sectional survey. J Med Ethics. 2022;48:695–701. 10.1136/medethics-2021-107818. PubMed

Moodley K, Kabanda SM, Kleinsmidt A, et al. COVID-19 underscores the important role of clinical Ethics committees in Africa. BMC Med Ethics. 2021;22(1):131. 10.1186/s12910-021-00696-2. PubMed PMC

Černá Pařízková R, Šustek P, Prudil L et al. Stanovisko výboru ČSARIM 13/2020: Rozhodování u pacientů v intenzivní péči v situaci nedostatku vzácných zdrojů. MZCR 13/2020. https://www.mzcr.cz/wp-content/uploads/2021/01/Stanovisko_CSARIM_CSIM_SIL_CPFS_Omezene_zdroje_casopis_AIM_2020.pdf

Conradi E, Biller-Andorno N, Boos M, et al. Gender in medical ethics: re-examining the conceptual basis of empirical research. Med Health Care Philos. 2003;6(1):51–8. 10.1023/A:1022514821765. PubMed

Bilwani S, Anjum G. Gender differences in making Moral decisions: the Ethics of Care Perspective in Pakistan. Eth Soc Wel. 2022;16(1):73–89. 10.1080/17496535.2021.1937264.

Zielina M, Škoda J, Ivanová K, Dostál D, Juríčková L, Anthony Procházka D, Straka B, Doležal A. Exploring moral competence regression: a narrative approach in medical ethics education for medical students. BMC Med Ethics. 2024;25(1):73. 10.1186/s12910-024-01073-5. PubMed PMC

Hong DZ, Goh JL, Ong ZY, et al. Postgraduate ethics training programs: a systematic scoping review. BMC Med Educ. 2021;21:338. 10.1186/s12909-021-02644-5. PubMed PMC

Roberts LW, Warner TD, Hammond KA, et al. Becoming a good doctor: perceived need for ethics training focused on practical and professional development topics. Acad Psychiatry. 2005;29(3):301–9. 10.1176/appi.ap.29.3.301. PubMed PMC

Saxena A, Bouvier PA, Shamsi-Gooshki E, et al. WHO guidance on ethics in outbreaks and the COVID-19 pandemic: a critical appraisal. J Med Ethics. 2021;47:367–73. 10.1136/medethics-2020-106959. PubMed

Santana-López BN, Santana-Padilla YG, Bernat-Adell MD, et al. The Need for Psychological Support of Health Workers during the COVID-19 pandemic and the influence on their work. Int J Environm Res Pub Health. 2022;19(15):8970. 10.3390/ijerph19158970. PubMed PMC

Dunham AM, Rieder TN, Humbyrd CJ. A bioethical perspective for navigating Moral dilemmas amidst the COVID-19 pandemic. J Am Acad Orthop Surg. 2020;28(11):471–6. 10.5435/JAAOS-D-20-00371. PubMed PMC

Vittone S, Sotomayor CR. Moral distress entangled: patients and providers in the COVID-19 era. HEC Forum. 2021;33(4):415–23. 10.1007/s10730-021-09450-y. PubMed PMC

Cheung ATM, Parent B. Mistrust and inconsistency during COVID-19: considerations for resource allocation guidelines that prioritise healthcare workers. J Med Ethics. 2021;47(2):73–7. 10.1136/medethics-2020-106801. PubMed

Street AE, Street DJ, Flynn GM. Who gets the last Bed? A discrete-choice experiment Examining General Population preferences for Intensive Care Bed Prioritization in a pandemic. Med Decis Mak. 2021;41(4):408–18. 10.1177/0272989X21996615. PubMed PMC

Ismail H, Marshall VD, Patel M, et al. The impact of the COVID-19 pandemic on medical conditions and medication adherence in people with chronic diseases. J Am Pharm Assoc. 2022;62(3):834–9. 10.1016/j.japh.2021.11.013. PubMed PMC

Schlögl M, Singler K, Martinez-Velilla N, et al. Communication during the COVID-19 pandemic: evaluation study on self-perceived competences and views of health care professionals. Eur Geriatr Med. 2021;12(6):1181–90. 10.1007/s41999-021-00532-1. PubMed PMC

Díaz-Agea JL, Orcajada-Muñoz I, Leal-Costa C, et al. How did the pandemic affect communication in clinical settings? A qualitative study with critical and Emergency Care nurses. Healthcare. 2022;10(2):373. 10.3390/healthcare10020373. PubMed PMC

Galvagni L, Nicoletti M. Facing a pandemic outbreak: global health, ethics, and technology issues. Theor Med Bioeth. 2024;45(3):159–65. 10.1007/s11017-024-09668-0. Epub 2024 May 25. PMID: 38789699. PubMed

Ho A, Dascalu I. Relational solidarity and COVID-19: an ethical approach to disrupt the global health disparity pathway. Glob Bioeth. 2021;32(1):34–50. 10.1080/11287462.2021.1898090. PubMed PMC

Aguilera B, Donya RS, Vélez CM, Kapiriri L, Abelson J, Nouvet E, Danis M, Goold S, Williams I, Noorulhuda M. Stakeholder participation in the COVID-19 pandemic preparedness and response plans: a synthesis of findings from 70 countries. Health Policy. 2024;142:105013. Epub 2024 Feb 8. PMID: 38401332. PubMed

https://www.who.int/publications/i/item/WHO-2019-nCoV-Policy_brief-pandemic_preparedness-2022.1

https://www.niaid.nih.gov/grants-contracts/peruse-pandemic-preparedness-plan

https://www.ecdc.europa.eu/en/seasonal-influenza/preparedness/why-pandemic-preparedness